Electric Infrastructure Reconducts RFP.pdf

ELECTRIC INFRASTRUCTURE RECONDUCTS RFP

RFP #2026-28

Release Date: October 23, 2026

City of Covington 2194 Emory Street

Covington, Georgia 30014

The City of Covington, Georgia, is seeking qualified contractors to submit proposals for the reconduct of three-phase overhead utility lines consisting of three separate projects in Covington, GA. Sealed proposals must be received by the Purchasing Department, at City Hall by Tuesday, November 24, 2026, at 10:00 AM.

A mandatory pre-proposal meeting will be held on November 9,2026 10:00am at the Covington Utility Complex located at 11631 Hwy 142, Covington, GA 30014.

The City of Covington will consider the competency and responsibility of bidders in making the award. City of Covington reserves the right to reject any and all bids, to waive informalities and technicalities, to reject portions of the bids and to award contracts in a manner consistent with the City and laws governing the State of Georgia.

SCOPE AND SPECIFICATIONS

The City of Covington, Georgia, is seeking qualified contractors to submit proposals for the reconduct of overhead utility lines for three separate projects in Covington, GA. All materials for the project will be supplied by the City of Covington. The contract is expected to be awarded during the third week of December 2026 and must be completed by May 31, 2027. The selected contractor will be responsible for all labor, equipment, and coordination required to complete the project within the specified time frame.

Proposals are due to the City of Covington Utility Complex, attention Scott Cromer located at 11631 Hwy 142, Covington, Georgia 30014 by 10:00 am on Tuesday, November 24, 2026. Late proposals will not be accepted.

Please submit two (2) sealed hard copies and one (1) copy on a USB drive to

City of Covington Purchasing Department

Marked: (2026-28 Electric Infrastructure Reconducts RFP)

Attention Scott Cromer

11631 Hwy 142 (Covington Utility Complex)

Covington, Georgia 30014

SPECIAL TERMS AND CONDITIONS

Submission of Proposals

Proposals shall be enclosed in sealed envelopes, addressed to the City of Covington Purchasing Department with the name of the bidder and marked “RFP#2026-28 Electric Infrastructure Reconducts RFP”. Proposals must be received in the Purchasing Department no later than the date and time (determined by the date/time stamp in the department) set forth in the Invitation to Bid. It is the sole responsibility of the bidder to ensure that their bid/proposal reaches the Purchasing Department. Any addenda should be enclosed in the sealed envelopes as well.

Unsigned bids will not be considered except in cases where bid is enclosed with other documents, which have been signed. The City will determine this.

Sales and Use Tax Liability

Effective July 1, 2005, House Bill 306 modified O.C.G.A. Title 48, Sales and Use Tax Liability. This modification imposes additional obligations and liabilities on local governments who acquire materials and/or equipment on behalf of private contractors hired by local governments for capital projects.

O.C.G.A. Title 48, Chapter 8, Section 63 imposes a use tax liability of 7%, equivalent to the sales tax liability, on private contractors when materials and equipment are purchased by a public agency using their tax-exempt status for a public works construction contract. Contractors are liable for the payment of a use tax on the materials and equipment supplied by local governments.

City of Covington is exempt from federal excise tax and Georgia sales tax with regards to goods and services purchased directly by City of Covington. Suppliers and contractors are responsible for federal excise tax and sales tax, including any taxes for materials incorporated in City construction projects.

Suppliers and contractors should contact the State of Georgia Sales Tax Division for additional information. Tax Exemption Certificates will be furnished upon request.

Information submitted by a bidder in the bidding process shall be subject to disclosure after the public opening in accordance with the Georgia Open Records Act. Each page of proprietary information must be identified. Entire bid may not be deemed proprietary.

Requirements

A. General:

1. The contractor’s personnel shall have the qualifications, knowledge, and experience to properly and reliably perform the Services described herein.

2. The contractor shall always provide sufficient qualified personnel to perform the services required in a timely, accurate, and professional manner.

3. The contractor shall perform all work in coordination with the City’s schedule and/or other contractors engaged by the City.

a Contractor shall take necessary precautions to protect any adjacent facilities and/or environment during the course of installation.

b Contractor must clean up site after completion of the work and must dispose of all trash, materials, packaging, etc.

The contractor will be responsible for all traffic control and conform to the guidelines set forth by the Manual on Uniformed Traffic Control Devices, Part 6.

Proposals will be considered only from experienced and well-equipped Contractors engaged in work of this type and magnitude.

Bidders may be required to submit evidence setting forth qualifications which entitle him to considerations as a responsible Contractor. A list of work of similar character successfully completed within the last two years may be required giving the location, size and listing equipment available for use on this work. Before accepting any bid, the City may require evidence of the Contractor's financial ability to successfully perform the work to be accomplished under the contract.

The City may make such investigations as it deems necessary to determine the ability of the Bidder to perform the work, and the Bidder shall furnish to the City all such information and data for this purpose as the City may request. The City reserves the right to reject any bid if the evidence submitted by, or investigation of, such Bidder fails to satisfy the City that such Bidder is properly qualified to carry out the obligations of the Contract and to complete the work contemplated therein.

Conditional bids will not be accepted.

INSURANCE:

Contractor shall maintain the following minimum insurance, (a) comprehensive general liability, including blanket contractual, covering bodily injuries with limits of no less than $1,000,000 per occurrence; and (b) commercial automobile liability, including blanket contractual, covering bodily injuries with limits of no less than $1,000,000 per occurrence, and property damage with no limits of no less than $1,000,000 per accident, (c) statutory worker’s compensation insurance, including $1,000,000 employer’s liability insurance

Contractor shall include in their bid, a certificate or policy of insurance evidencing Contractor’s compliance with this paragraph with the City of Covington listed as the certificate holder. Contractor shall abide by all terms and conditions of the insurance and shall do nothing to impair or invalidate the coverage.

BONDS:

All bids must be accompanied by a Bid Bond in an amount not less than five percent (5%) of the Base Bid.

Performance Bond and Payment Bond, each in the amount of one hundred percent (100%) of the contract amount, will be required of the successful bidder and must be provided to the City within ten

(10) days of being notified of the award.

Bonds must be written by an acceptable Surety Company licensed to do business in the State of Georgia and listed in the Department of the Treasury, Circular 570, latest edition.

PERMITS:

The City will secure and pay for all GDOT permits, assessments, charges or fees required in connection with the proposed construction.

ILLEGAL IMMIGRATION REFORM AND ENFORCEMENT ACT OF 2011

Vendors submitting a Qualification package in response to this RFP must complete the Contractor Affidavit under O.C.G.A. §13-10-91(b)(1) which is provided with the RFP package to verify compliance with the Illegal Immigration Reform and Enforcement Act of 2011.

A. The form must be signed by an authorized officer of the contractor or their authorized agent.

B. The form must be notarized.

C. The contractor will be required to have all subcontractors and sub-subcontractors who are engaged to complete physical performance of services under the final contract executed between the City and the contractor complete the appropriate subcontractor and sub-subcontractor affidavits.

GENERAL INFORMATION:

RECEIPT OF BID/PROPOSAL:

No proposals/bids received after said time or at any place other than the time and place as stated in the notice shall be considered. No responsibility shall attach to City of Covington for the premature opening of a bid not properly addressed and identified.

WITHDRAWAL OF BID/PROPOSAL:

A bidder may withdraw their proposal before the due date, without prejudice to the bidder, by submitting a written request of withdrawal to the City of Covington Purchasing Department.

Bids may not be withdrawn for a period of sixty (60) days from the due date.

REJECTION OF BID / PROPOSAL

City of Covington may reject any and all proposals and must reject a bid of any party who has been delinquent or unfaithful in any formal contract with the City of Covington. Also, the right is reserved to waive any irregularities or informalities in any bid in the proposing procedure. The City of Covington shall be the sole judge as to which proposal is best, and in ascertaining this, will take into consideration the business integrity, financial resources, facilities for performing the work, and experience in similar operations of the various bidders.

STATEMENT OF EXPERIENCE AND QUALIFICATIONS:

The bidder may be required, upon request, to prove to the satisfaction of the City of Covington that he/she has the skill, experience, necessary facilities and ample financial resources to perform the contract(s) in a satisfactory manner and within the required time. If the available evidence of competency of any bidder is not satisfactory, the bid of such bidder may be rejected. The successful bidder is required to comply with and abide by all applicable federal and state laws in effect at the time the contract is awarded.

NON-COLLUSION AFFIDAVIT:

By submitting a bid, the bidder represents and warrants that such bid is genuine and not sham or collusive or made in the interest or in behalf of any person not therein named, that the bidder has not directly or indirectly induced or solicited any other bidder to put in a sham bid, or any other person, firm or corporation to refrain from proposing and that the bidder has not in any manner sought by collusion to secure to that bidder any advantage over any other bidder.

DOCUMENTS DEEMED PART OF THE CONTRACT:

The notice, invitation to bidders, general conditions, and instructions for bidders, special conditions, specifications, bid, and addenda, if any, will be deemed part of the contract.

GOVERNING LAWS:

This contract is made under and shall be governed and construed in accordance with the laws of the State of Georgia.

ERRORS AND OMISSIONS:

The vendor shall not take advantage of any errors or omissions in this proposal, and shall promptly notify the City of Covington of any omissions or errors found in this document.

TORT IMMUNITY:

No officer, employee, or agent of the City acting within the scope of his/her employment or function shall be held personally liable in tort or named as a defendant in any action for injury or damage suffered because of any act, event, or failure to act.

SILENCE OF SPECIFICATIONS

The apparent silence of these specifications and any supplemental specifications as to any details, or the omission from it of a detailed description concerning any point, shall be regarded as meaning that only the best commercial practices are to prevail and that only materials of first quality and correct type, size and design are to be used. All workmanship is to be first quality. All interpretations of this specification shall be made upon the basis of this statement, with City interpretation to prevail.

OPTION TO AUDIT

Successful bidder will be required to maintain complete records during the life of the contract and for a period of one year after completion of the contract. Such records are to be made available to the City if officially requested, to be audited by designated City auditing staff. In such audits reveal overcharges and/or undercharges, such will be adjusted and compensation made by either party to correct charges.

Scope of Work The scope of the projects includes the following:

Project 1: Cornish Creek Newtonsboro Rd Reconduct

1. Utility Line Extension:

o Reconduct three-phase overhead utility to larger conductor three-phase lines along Newtonsboro Rd starting at Alcovy Rd to Cornish Creek Water Treatment Plant, approximately 0.61 miles. Ensure all utility lines are properly installed and comply with all relevant local, state, and federal regulations.

2. Installation Requirements:

o Provide labor, tools, equipment, and supervision required to perform the work safely and efficiently.

o Work will involve the installation of poles, crossarms, conductors, hardware, and other associated equipment (all of which will be provided by the City).

o Ensure that all installation methods are in accordance with standard utility practices.

3. Traffic Control and Safety:

o Implement and maintain appropriate traffic control measures to ensure the safety of workers, road users, and pedestrians during construction.

o Coordinate with local authorities for any required road closures or lane shifts.

4. Site Restoration:

o Upon completion of the project, the contractor is responsible for restoring any disturbed areas to their original condition, including regrading and reseeding if necessary.

5. Inspection and Testing:

o The contractor must work closely with the City of Covington’s inspectors to ensure that all work meets the required specifications.

o Upon completion, the contractor must be available for final inspections and testing of the system.

6. Timeline:

o All work must be completed by May 31th, 2027. The project must meet this deadline with no exceptions unless approved by the City of Covington.

Project 2: Elm St Reconduct

1. Utility Line Extension:

o Reconduct three-phase overhead utility to larger conductor three-phase lines along Elm St and Reynold

St. From 1140 Reynold St to 1139 Church St along Reynolds St and 1139 Church St to 1112 Williams St along Elm St for an approximate 0.40 miles. Ensure all utility lines are properly installed and comply with all relevant local, state, and federal regulations.

2. Installation Requirements:

o Provide labor, tools, equipment, and supervision required to perform the work safely and efficiently.

o Work will involve the installation of poles, crossarms, conductors, hardware, and other associated equipment (all of which will be provided by the City).

o Ensure that all installation methods are in accordance with standard utility practices.

3. Traffic Control and Safety:

o Implement and maintain appropriate traffic control measures to ensure the safety of workers, road users, and pedestrians during construction.

o Coordinate with local authorities for any required road closures or lane shifts.

4. Site Restoration:

o Upon completion of the project, the contractor is responsible for restoring any disturbed areas to their original condition, including regrading and reseeding if necessary.

5. Inspection and Testing:

o The contractor must work closely with the City of Covington’s inspectors to ensure that all work meets the required specifications.

o Upon completion, the contractor must be available for final inspections and testing of the system.

6. Timeline:

o All work must be completed by May 31th, 2027, with the planned start date of January 4th, 2027. The project must meet this deadline with no exceptions unless approved by the City of Covington.

Project 3: Covington #6 Feeder Reconduct

1. Utility Line Extension:

o Reconduct three-phase overhead to larger conductor three-phase lines along Hwy 278 and Hwy 11.

Overhead work from 34 Hwy 11 to 202 Hwy 11. This is approximately 0.35 miles. Ensure all utility lines are properly installed and comply with all relevant local, state, and federal regulations.

2. Installation Requirements:

o Provide labor, tools, equipment, and supervision required to perform the work safely and efficiently.

o Work will involve the installation of poles, crossarms, conductors, hardware, and other associated equipment (all of which will be provided by the City).

o Ensure that all installation methods are in accordance with standard utility practices.

3. Traffic Control and Safety:

o Implement and maintain appropriate traffic control measures to ensure the safety of workers, road users, and pedestrians during construction.

o Coordinate with local authorities for any required road closures or lane shifts.

4. Site Restoration:

o Upon completion of the project, the contractor is responsible for restoring any disturbed areas to their original condition, including regrading and reseeding if necessary.

5. Inspection and Testing:

o The contractor must work closely with the City of Covington’s inspectors to ensure that all work meets the required specifications.

o Upon completion, the contractor must be available for final inspections and testing of the system.

6. Timeline:

o All work must be completed by May 31th, 2027. The project must meet this deadline with no exceptions unless approved by the City of Covington.

Requirements for Submission Interested contractors must submit the following items as part of their proposal:

1. Company Information:

o Name, address, and contact information for the bidding company.

o A brief description of the company’s experience in utility line installation, including any relevant projects completed.

2. Project Approach and Timeline:

o A proposed schedule indicating key milestones and expected completion dates for each phase of the project(s). Note, projects must be completed by May 31st, 2027.

3. Team Qualifications:

o Copies of relevant certifications, licenses, or training required for the work.

4. Cost Estimate:

o A detailed cost proposal for each of the three (3) projects and one (1) grand total cost value for all three projects. This shall include all labor, equipment, and other expenses associated with completing the project(s).

o The proposal should clearly outline any applicable costs for project management, overhead, and materials (noting that materials will be supplied by the City of Covington).

5. References:

o At least three references from previous clients for similar projects completed in the past 5 years.

Evaluation Criteria Proposals will be evaluated based on the following factors:

1. Experience and Qualifications:

o Demonstrated experience in completing similar utility line extension projects.

o Qualifications and certifications of personnel involved in the project.

2. Project Approach:

o The clarity and feasibility of the project approach, including the proposed timeline and work plan.

3. Cost:

o The reasonableness and competitiveness of the cost proposal.

4. Safety Record:

o The contractor’s safety record, including any relevant safety certifications or adherence to safety practices.

5. References:

o Quality and relevance of provided references.

Terms and Conditions

• All work must comply with the City of Covington’s codes, ordinances, and policies, as well as applicable local, state, and federal regulations.

• The City of Covington reserves the right to make changes to the scope of work and timelines as deemed necessary.

• The successful contractor must carry, City of Covington required as detailed, insurance, including general liability and workers' compensation coverage, throughout the duration of the project.

CONTACT FOR THIS REQUEST:

All questions regarding this RFP shall be made via email to Brandon Cole at bcole@cityofcovington.org. The deadline to submit a question is 3:00 P.M. local time Thursday, November 12, 2026. The City will post “Response to Questions and/or Addenda”, if applicable, on the City website, https://www.cityofcovington.org/index.php?section=businessopportunities, by 5:00 P.M.

on Tuesday, November 17, 2026. It is the responsibility of each proposer to verify the response to questions/addenda before submitting their proposal.

TIMELINE:

Release Date: October 23,2026

Mandatory Pre-Proposal Meeting: November 9th, 2026, at 10:00am

Questions Deadline: November 12th, 2026, by 3:00pm

Response to Questions & Addenda: November 17th, 2026, by 5:00pm

Proposals Due: November 24th, 2026. by 10:00am

Approval/Award: December 14th, 2026 (Anticipated) https://www.cityofcovington.org/index.php?section=business-opportunities

BID BOND, page 1 of 2

Five Percent (5%) of Bid

KNOW ALL MEN BY THESE PRESENTS, that we, the undersigned

, as Contractor, and

, as Surety, are hereby held and firmly bound unto CITY OF COVINGTON, GEORGIA, as CITY, in the penal sum of

Dollars ($ ) for the payment of which, well and truly to be made, we hereby jointly and severally bind ourselves, our heirs, executors, administrators, successors, and assigns.

Signed this day of , 2026.

The condition of the above obligation is such that whereas the Contractor has submitted to THE CITY OF COVINGTON, GEORGIA a certain Bid attached hereto and hereby made a part hereof to enter into a contract in writing for the following work:

Furnish all labor, materials, and equipment for the Overhead Utility Line Extension as describe in bid documents The City of Covington.

NOW, THEREFORE,

(a) If said Bid shall be rejected or in the alternate,

(b) If said Bid shall be accepted and the Contractor shall execute and deliver a Contract in the Form of

Contract attached hereto (properly complete in accordance with said Bid) and shall furnish a bond for his faithful performance of said Contract and for the payment of all persons performing labor or furnishing material in connection therewith, and shall in all other respects perform the agreement created by the acceptance of said Bid, then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated.

The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its bond shall be in no way impaired or affected by any extension of the time within which the City may accept such Bids, and said Surety does hereby waive notice of any such extension.

BID BOND page 2 of 2

IN WITNESS WHEREOF, the Contractor and the Surety have hereunto set their hands and seals, and such of them as are corporations have caused their corporate seals to be hereto affixed and these presents to be signed by their proper officers, the day and year first set forth above.

(SEAL)

Contractor

By:

(SEAL)

Surety

By:

Georgia Representative

City of Covington #2026-28 Electric Infrastructure Reconducts

RFP

Addenda Acknowledgements (if applicable) Each vendor is responsible for determining that all addenda issued by the City of Covington have been received before submitting a Bid. Any addendums will be posted on the City of Covington website at

Addenda Date Vendor

Received / Reviewed Initials "1"

"2"

"3"

"4"

"5"

"6"

"7"

"8"

"9"

"10"

Vendor Information:

Vendor Name __________________________________________

Address __________________________________________

Telephone __________________________________________

E-Mail __________________________________________

Representative (print name) _______________________________

Signature of Representative_______________________________

Date Submitted_________________________________________

Affidavit Verifying Status for City Public Benefit Application

By executing this affidavit under oath, as an applicant for the award of a contract with the City of Covington, Georgia, I . [Name of natural person applying on behalf of individual, business, corporation, partnership, or other private entity] am stating the following as required by O.C.G.A.

Section 50-36-1:

I am a United States citizen

OR

I am a legal permanent resident 18 years of age or older or I am an otherwise qualified alien or non-immigrant under the Federal Immigration and Nationality Act 18 years of age or older and lawfully present in the United States. *

In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of Code Section 16-10-20 of the Official Code of Georgia.

Signature of Applicant: Date

SUBSCRIBED AND SWORN Printed Name:

BEFORE ME ON THIS THE

DAY OF , 20 . _

Alien Registration number for non-citizens

Notary Public

My commission Expires:

*Note: O.C.G.A. § 50-36-1(e)(2) requires that aliens under the federal Immigration and Nationality Act, Title 8 U.S.C., as amended, provide their registration number. Because legal permanent residents are included in the federal definition of “alien”, legal permanent residents must also provide their alien registration number. Qualified aliens that do not have an alien registration number may supply another identifying number below.

CITY OF COVINGTON

NON-COLLUSION AFFIDAVIT OF CONTRACTOR

State of )

County of )

, being first duly sworn, deposes and says that:

(1) He is (owner, partner officer, representative, or agent) of , the Vendor that has submitted the attached RFP;

(2) He is fully informed respecting the preparation and contents of the attached RFP and of all pertinent circumstances respecting such RFP;

(3) Such RFP is genuine and is not a collusive or sham RFP;

(4) Neither the said Vendor nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affidavit, has in any way colluded, conspired, connived or agreed, directly or indirectly with any other Vendor, firm or person to submit a collusive or sham RFP in connection with the Contract for which the attached RFP has been submitted or refrain from proposing in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other Vendor, firm or person to fix the price or prices in the attached RFP or of any other Vendor, or to fix any overhead, profit or cost element of the proposing price or the proposing price of any other Vendor, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against the City of Covington or any person interested in the proposed Contract; and

(5) The price or prices quoted in the attached RFP are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Vendor or any of its agents, representatives, owners, employees, or parties in interest, including this affidavit.

(Signed)

(Title)

Subscribed and Sworn to before me this day of, 2026

Name

Title

Notary Public: My commission expires (Date)______________

CITY OF COVINGTON

NON-COLLUSION AFFIDAVIT OF SUB-CONTRACTOR

State of )

County of )

, being first duly sworn, deposes and says that: (1) He is (owner, partner officer, representative, or agent) of , the Vendor that has submitted the attached RFP;

(2) He is fully informed respecting the preparation and contents of the attached RFP and of all pertinent circumstances respecting such RFP;

(3) Such RFP is genuine and is not a collusive or sham RFP;

(4) Neither the said sub-contractor nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affidavit, has in any way colluded, conspired, connived or agreed, directly or indirectly with any other Vendor, firm or person to submit a collusive or sham RFP in connection with the Contract for which the attached RFP has been submitted or refrain from proposing in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other Vendor, firm or person to fix the price or prices in the attached RFP or of any other Vendor, or to fix any overhead, profit or cost element of the proposing price or the proposing price of any other Vendor, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against the City of Covington or any person interested in the proposed Contract; and

(5) The price or prices quoted in the attached RFP are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Vendor or any of its agents, representatives, owners, employees, or parties in interest, including this affidavit.

(Signed)

(Title)

Subscribed and Sworn to before me this day of, 2026

Name

Title

Notary Public: My commission expires (Date)______________

Contractor Affidavit under O.C.G.A. § 13-10-91(b)(1)

By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is engaged in the physical performance of services on behalf of CITY OF COVINGTON has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91.

Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will contract for the physical performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the contractor with the information required by O.C.G.A. § 13-10-91(b). Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization User Identification Number

Date of Authorization

Name of Contractor

Name of Project

Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on _, , 20___ in (city), (state).

Signature of Authorized Officer or Agent

Printed Name and Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME ON THIS

THE DAY OF , 20___.

NOTARY PUBLIC

My Commission Expires:

Sub-subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(4)

By executing this affidavit, the undersigned sub-contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is engaged in the physical performance of services under a contract for and on behalf of the CITY OF COVINGTON has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91. Furthermore, the undersigned sub-contractor will continue to use the federal work authorization program throughout the contract period and the undersigned sub-subcontractor will contract for the physical performance of services in satisfaction of such contract only with sub-subcontractors who present an affidavit to the sub-subcontractor with the information required by O.C.G.A. § 13-10-91(b). The undersigned sub-subcontractor shall submit, at the time of such contract, this affidavit to . Additionally, the undersigned sub-subcontractor will forward notice of the receipt of any affidavit from a sub-subcontractor to __________________________. Sub-subcontractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization User Identification Number

Date of Authorization

Name of Sub-subcontractor

Name of Project

Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on , , 20___ in (city), (state).

Signature of Authorized Officer or Agent

Printed Name and Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME ON THIS THE

DAY OF , 20___.

NOTARY PUBLIC

My Commission Expires:

SUBCONTRACTOR NOTIFICATION LIST

Required information on Subcontractors doing work in the City of Covington:

Please list any subcontractors, business license number, address, contact #, scope of work and percent of work assigned for each Subcontractor who may be doing work in the City.

General Contractor/Developer: ________________________________________

License Number: ________________________________________________________

Subcontractor: __________________________________________________________

License Number: __________________ Address__________________________________ Phone #____________________

Contact Name: ___________________________________________________________

Scope of Work: __________________________________________________________

Percent of Work: _________________

License Number: __________________ Address__________________________________ Phone #____________________

Contact Name: ___________________________________________________________

Percent of Work: _________________

License Number: __________________ Address__________________________________ Phone #____________________

Contact Name: ___________________________________________________________

Percent of Work: __________________